"Game-Changing" Contraceptive Approved for Self-Injection in Nigeria

A DKT Nigeria community health worker gives Sayana Press injectable contraceptive to a woman in the Makoko slum of Lagos, Nigeria. Photo by David Olson.

This was originally published on K4Health Blog on Jan. 4, 2017.

The Nigerian government has approved Sayana Press injectable contraceptive for self-injection by users, a change which advocates hope will improve access to the product. The United Kingdom has already approved self-injection. Other countries are considering doing the same.

Sayana Press is the three-month progestin-only injectable contraceptive that combines the drug and needle in a Uniject™ injection system. It is small, light, easy-to-use, and requires minimal training, making it ideal for rural settings and community-based distribution efforts and, increasingly, for women to administer themselves.

Since it was introduced in 2014, Sayana Press has been hailed as a “game-changer,” because of its ease of use and ability to be administered by lesser-skilled health professionals and now, even users themselves. This video shows how Sayana Press works.

PATH, which helped develop the Uniject™ injection system, has coordinated pilot introductions of Sayana Press in Burkina Faso, Niger, Senegal, and Uganda. The pilot period (July 2014-June 2016) has now ended and all four countries are moving towards scale-up. Sayana Press was administered to more than 120,000 new contraceptive users during the pilot.

PATH will conduct research on self-injection of Sayana Press through 2017 in collaboration with ministries of health in Senegal and Uganda. Research from Uganda just became available showing that self-injection of Sayana Press is both feasible and acceptable among women participating in the first such research study conducted in sub-Saharan Africa, according to results published online by the journal Contraception.

In 2014, DKT Nigeria became the first program to commercially introduce Sayana Press through social marketing in Africa, with funding from the Bill & Melinda Gates Foundation and the Children's Investment Fund Foundation and in partnership with Pfizer. DKT began distributing Sayana Press in seven southwestern states and has since expanded nationwide. It is available through hospitals, clinics, maternity homes, pharmacies and “DKT Bees,” a team of community health workers trained to bring confidential counseling and family planning services to a woman’s doorstep. The Bees operate in some of the most disadvantaged areas of Lagos.

Women using Sayana Press can also subscribe to DKT’s free SMS text message system to remind them when it’s time for their next injection. The system generated such excitement at a recent stakeholders’ meeting in Nigeria that UNFPA asked DKT to leverage the reminder service for their users in the public sector.

It will take some time before self-injection is practiced in Nigeria, said Dimos Sakellaridis, country director of DKT Nigeria. The Federal Ministry of Health wants to coordinate the effort among all partners and stakeholders.

“In the short term, I do not see any significant changes on how we market and promote Sayana Press in Nigeria,” said Sakellaridis. “However, the long-term benefit will be massive. Accessibility of Sayana Press will increase drastically and some of the product advantages, such as discretion, will be greatly appreciated by users.”

The University of California, San Francisco, has been providing monitoring and evaluation support to DKT Nigeria since October 2015 and found that 29% of the buyers of Sayana Press were new modern contraceptive users.

A DKT Nigeria brief just published shows progress through October 2016:

• Over 4,000 providers at hospital, clinics, maternity homes, and pharmacies have been trained on Sayana Press.
• More facilities are restocking the product each month.
• Over 9,000 women have subscribed to the SMS reminder alerts.

Sakellaridis says that he expects DKT Nigeria to sell over 500,000 units in 2016 and “could sell even more if we had the stock.”

DKT Democratic Republic of Congo also has Sayana Press on the market, but has been hampered by low stocks. They have just received 200,000 units and plan a major campaign in 2017.

DKT DRC plans to incorporate the “Bees” concept in the six provinces where it operates, said Country Director Jacques-Antoine Martin. For example, DKT will reach the isolated Équateur Province with a boat on the Congo River, supported by motorcycles that will visit the villages around each boat stop. DKT also supports Sayana Press self-injection, which is in its test phase in the province of Kongo-Central.